Larry A. Chinitz, M.D.

Spinal cord stimulation prevents tachypacing-induced atrial fibrillation
Bernstein S.A.; Wong B.; Holmes D.S.; Kuznekoff L.M.; Rooke R.; Alvstrand M.; Vasquez C.; Bharmi R.; Shah R.; Rosenberg S.P.; Farazi T.G.; Chinitz L.; Morley G.E.
2011 ;8(5 SUPPL 1):S330-S330, Heart rhythm
Introduction: Spinal cord stimulation (SCS) has been shown to modulate atrial electrophysiology and confer protection against ischemia and ventricular arrhythmias. We hypothesized that SCS may reduce susceptibility to tachypacing (TP) induced atrial fibrillation (AF). Methods: Spinal cord leads (Octrode, St. Jude Medical) were implanted in the upper thoracic spine (T1-T5) of canines and connected to pulse generators (EonC, St. Jude Medical). The AV node was ablated and atrial effective refractory period (AERP) was measured at baseline and with SCS (n=10). In separate animals the AV node was ablated and endocardial RA and RV pacing leads were connected to dual chamber pacemakers for ambulatory AF induction. Custom firmware provided continuous 30s periods of atrial TP followed by 6s sense windows. TP was interrupted by detection of AF (atrial rate >250 bpm) and resumed upon return to sinus rhythm. AF Index was defined as the fraction of time the animal did not receive TP relative to the total allowable TP time. The effect of SCS delivered intermittently for 6 hr/day (SCS ON; n=3) on AF index was followed for 8 weeks and compared to control (SCS OFF; n=3). Results: Right (p=0.002) and left (p=0.009) AERP were significantly longer during SCS (168+/-15.1, 168+/-14.8 ms) compared to baseline (130+/-8.7, 152+/-10.3 ms). AF Index was significantly decreased in the SCS ON compared to SCS OFF (p<0.0001). AF Index was >70% in the SCS OFF group and <5% in the SCS ON animals starting at week 3 (Figure). Conclusions: These data demonstrate that SCS prolongs AERP and prevents TP-induced AE (Graph presented)
— id: 131860, year: 2011, vol: 8, page: S330, stat: Journal Article,

Contact sensing provides a highly accurate means to titrate radiofrequency ablation lesion depth
Holmes, Douglas; Fish, Jeffrey M; Byrd, Israel A; Dando, Jeremy D; Fowler, Steven J; Cao, Hong; Jensen, James A; Puryear, Harry A; Chinitz, Larry A
2011 Jun;22(6):684-690, Journal of cardiovascular electrophysiology
BACKGROUND: Transmural lesions are essential for efficacious ablation. There are, however, no accurate means to estimate lesion depth. OBJECTIVE: Explore use of the electrical coupling index (ECI) from the EnSite Contact System as a potential variable for lesion depth estimation. METHODS: Radiofrequency (RF) ablation lesions were created in atria and the thighs of swine using an irrigated RF catheter. Power was 30 W for 20 or 30 seconds intracardiac and 30-50 W for 10-60 seconds for the thigh. Intracardiac, the percentage change in ECI during ablation was compared with transmurality and collateral damage occurrence. For the thigh model, an algorithm estimating lesion depth was derived. Factors included: power, duration, and change in the ECI subcomponents (DeltaECI+) during ablation. The DeltaECI+ algorithm was compared to one using power and duration (PD) alone. RESULTS: Intracardiac, lesions with >/=12% reduction in ECI were more likely to be transmural (92.3% vs. 59.4%, P < 0.001). Twenty-second lesions were less likely to cause collateral damage compared to 30 seconds (33% vs. 70%, P = 0.003), while transmurality was similar. With the thigh model, DeltaECI+ had a better correlation than the PD algorithm (P < 0.01). Accuracy of the DeltaECI+ algorithm was unimproved with inclusion of tip orientation, while PD improved (R(2) = 0.64). DISCUSSION: Change in ECI provides evidence of transmural versus nontransmural swine intracardiac atrial lesions. A lesion depth estimation algorithm using ECI subcomponents is unaffected by tip orientation and is more accurate than using PD alone. CONCLUSION: Use of ECI as a factor in a lesion depth algorithm may provide clinically valuable information regarding the efficacy of intracardiac RF ablation lesions
— id: 136471, year: 2011, vol: 22, page: 684, stat: Journal Article,

Meta-analysis to assess the appropriate endpoint for slow pathway ablation of atrioventricular nodal reentrant tachycardia
Stern, Joshua D; Rolnitzky, Linda; Goldberg, Judith D; Chinitz, Larry A; Holmes, Douglas S; Bernstein, Neil E; Bernstein, Scott A; Khairy, Paul; Aizer, Anthony
2011 Mar;34(3):269-277, Pacing & clinical electrophysiology
BACKGROUND: There are little data on the appropriate endpoint for slow pathway ablation that balances acceptable procedural times, recurrence rates, and complication rates. This study compared recurrence rates of three commonly utilized endpoints of slow pathway ablation for atrioventricular nodal reentrant tachycardia (AVNRT). METHODS: We performed a meta-analysis of AVNRT slow pathway ablation cohorts by searching electronic databases, the Internet, and conference proceedings. Inclusion criteria were age >18 years, >20 human subjects per study, primary AVNRT ablation, English language publication, and >1 month of follow-up. Data were analyzed with a fixed-effects model using Comprehensive Meta-Analysis software version 2.2.046 (Biostat, Englewood, NJ, USA). RESULTS: We included 10 studies encompassing 1,204 patients with a mean age of 41-53 years. Endpoints were complete slow pathway ablation, residual jump only, and single remaining echo beat. Pooled estimates revealed 28 of 641 patients (4.4%) with complete slow pathway ablation, 13 of 192 patients (6.8%) with a residual jump only, and 24 of 371 patients (6.5%) with one echo had recurrences. With uniform isoproterenol use after ablation, there was no significant difference in recurrence rates among the endpoints. However, when isoproterenol was utilized after ablation only if needed to induce AVNRT before ablation, a significantly higher recurrence rate occurred in patients with a residual jump (P = 0.002), a single echo (P = 0.003), or the combined group of a residual jump and/or one echo (P = 0.001). CONCLUSIONS: Isoproterenol should be used routinely after slow pathway modification, when a residual jump and/or single echo remain
— id: 132603, year: 2011, vol: 34, page: 269, stat: Journal Article,

An unusual preinduction arrhythmia resulting from the presence of a Mahaim fiber
Zweifler, Iris A; Rosenberg, Andrew D; Chinitz, Larry
2011 Sep;23(6):489-491, Journal of clinical anesthesia
A potentially life-threatening arrhythmia appeared on the preinduction electrocardiogram of an asymptomatic young woman prior to spine surgery. The patient was evaluated by electrophysiology and had a rare accessory pathway, a Mahaim Fiber
— id: 137440, year: 2011, vol: 23, page: 489, stat: Journal Article,

A novel mechanism of failure to detect atrial arrhythmias by pacemakers and implantable cardioverter defibrillators
Rose, Emily; Chinitz, Larry A; Holmes, Douglas S; Aizer, Anthony
2010 Mar;21(3):325-328, Journal of cardiovascular electrophysiology
A 64-year-old man with complete heart block, status post-Medtronic dual chamber pacemaker insertion, failed ablation for atrial tachycardia at an outside institution. Despite persistent palpitations and known unsuccessful ablation, pacemaker interrogation revealed no evidence of atrial arrhythmias. At electrophysiology study, burst pacing from the high right atrium and distal coronary sinus at 370 ms revealed bidirectional 2:1 interatrial conduction block. Left atrial burst pacing at 260 ms induced an atrial tachycardia (cycle length 340 ms) with 2:1 left to right atrial block and right atrial activation at 680 ms. The tachycardia was localized to the lateral left atrial roof. A series of ablation lesions from left to right superior pulmonary vein terminated the tachycardia. Left to right interatrial conduction block is a mechanism for underdetection of atrial arrhythmias with implantable devices not previously described. As the extent of atrial ablation increases, the incidence of this mechanism of underdetection may increase. Though devices are often considered ideal for atrial arrhythmia detection and are used in multiple trials, detection failures can occur despite appropriate device function. This case underscores the need for electrocardiographic monitoring in addition to device-based electrogram monitoring
— id: 133300, year: 2010, vol: 21, page: 325, stat: Journal Article,

Right-sided implantation and subpectoral position are predisposing factors for fidelis lead fractures
Bernstein N.E.; Karam E.T.; Wong B.; Aizer A.; Holmes D.S.; Bernstein S.A.; Chinitz L.A.
2009 ;6(5 SUPPL 1):S192-S192, Heart rhythm
Introduction: The Medtronic Fidelis lead family is associated with an unacceptable incidence of premature lead failure. Multiple studies have attempted to identify risk factors for lead failure and include younger age, better ejection fraction, and non-cephalic access. We hypothesized that other factors leading to potential increased forces on the lead including right-sided implantation or subpectoral positioning may be associated with premature lead failure. Methods: We reviewed the implant data from our group and identified 220 patients who received a Medtronic 6949 (dual coil) or 6931 (single coil) Fidelis lead. Implant data including age, sex, venous access site, implant side, implant location, lead length, and number of venous leads was reviewed. Hospital, Pacemaker Clinic, and Medtronic registration database were reviewed for evidence of lead failure, replacement, or abandonment. Data was evaluated in a univariate and multivariate analysis. Results: Of the 220 Fidelis leads implanted, 9 (4%) were noted to develop malfunction. This presented as inappropriate shocks from sensed noise, or elevated impedance measurements. Of the above noted implant features, only right-sided (vs. left-sided) implant, and subpectoral implant (vs. prepectoral) were found in uni- and multivariate analysis to be predictive of lead failure. Of 13 right-sided lead implants, 4 (30.7%) fractured (p<0.001). Of 14 subpectoral implants, 3 (21%) had lead failure (p<0.001). Conclusions: We have identified both right sided implantation and subpectoral generator positioning as factors associated with premature lead malfunction in the Fidelis lead family. Clinical decisions regarding patient management should incorporate these findings in regard to lead replacement in high risk patients
— id: 131855, year: 2009, vol: 6, page: S192, stat: Journal Article,

Brugada syndrome in children
Fowler S.J.; Bloise R.; Monteforte N.; Cerrone M.; Napolitano C.; Chinitz L.; Priori S.G.
2009 ;6(5 SUPPL 1):S86-S86, Heart rhythm
Introduction: Brugada syndrome (BrS) is a heritable arrhythmogenic disease characterized by an augmented risk of sudden cardiac arrest (SCA). Studies on the pediatric population are few and on a limited number of patients. We describe the natural history of 90 children with BrS and on 48 genotyped patients with BrS, representing the largest series of child carriers of SCN5A mutations reported to date. Methods: 90 children (63 males) clinically and/or genetically affected by BrS, mean 10+/-6y, from 64 different families were studied using retrospective case review. Results: Type I or II ECG was observed in 40 patients (pts); 21 pts had ECG type I and 19 pts had ECG type II; 25 during protocol drug infusion and 5 with fever; 46 pts were studied because carriers of BrS mutations, despite normal ECG. Among the 21 patients with a spontaneous type I ECG, 4 were symptomatic (19%) and among the 19 patients with a spontaneous type II ECG, 5 were symptomatic (26%). 2/25, patients with a drug-induced phenotype were symptomatic (8%). Male predominance was observed in the symptomatic group (boys, 77%; girls, 30%). Family history of SCA was present in 35/90 pts. EP study, performed in 16 pts, was positive in only 1. ICD was implanted in 6 pts. During a mean follow-up of 50+/-34 months, 1 child experienced syncope; all other pts remained asymptomatic. Genetic screening for SCN5A was performed in 32 probands (pbs): 16 were carriers of a genetic defect. 57 pts were studied because of family history of BrS; 52 were carriers of the mutation found in their pbs, 5 belong to families with unknown genotype, but were clinically affected. Conclusions: In the pediatric population, ECG pattern and clinical manifestation of BrS are present in a small percentage of pts, suggesting a more subtle phenotype. Symptoms or ECG pattern can be precipitated by fever. Also, the role of EP study is not conclusive in pediatric BrS. In contrast to adults, some 50% of pediatric pbs are genetically affected, suggesting that a strict clinical selection of pts for SCN5A screening may lead to higher genotyping success
— id: 131850, year: 2009, vol: 6, page: S86, stat: Journal Article,

Clinical comparison of ICD detection algorithms that include rapid VT zones
Hirsh D.; Bernstein N.E.; Holmes D.S.; Chinitz L.A.; Rao S.; Aizer A.
2009 ;6(5 SUPPL 1):S184-S185, Heart rhythm
Introduction: Although the majority of rapid monomorphic VTs (faster than 320ms) can be ATP terminated, only Medtronic (MDT) has validated the clinical safety of its detection algorithm to distinguish rapid VT from VF. We set out to determine the performance characteristics of the Boston Scientific (BSC), MDT, and St. Jude Medical (SJM) ICD detection algorithms for VF at the time of ICD implantation and testing. Methods: Data on the detection of induced-VF at device implantation was collected on 62 consecutive patients in a non-randomized prospective cohort. Multi-zone programming for the BSC, MDT and SJM devices was based on data from the PAINFREE-II Trial. R-wave sensing at all implantations was performed with a Medtronic analyzer. Results: 62 patients were included and 124 tests for VFdetection were performed (Table). There were no differences in R-wave sensing or programmed sensitivity among groups. Compared to MDT and SJM, the BSC group had a significantly greater percentage of tests where charging occurred >5s from VF-induction. Mean time to charge initiation was 8s in 19.4% of tests in the BSC group. Marker channel/EGM analysis revealed that prolonged charge times resulted from inappropriate ATP and/or delayed VT/VF discrimination. Conclusions: The BSC VT/VF discrimination algorithm commonly results in delayed VF-detection when programmed with a VT zone from 240 to 320ms. This frequently translates into a prolonged time to device charge initiation. Further studies are needed to determine whether this prolonged detection time leads to clinically significant events. (Table presented)
— id: 131854, year: 2009, vol: 6, page: S184, stat: Journal Article,

Purkinje fiber-mediated idiopathic ventricular fibrillation mapping to left ventricular diverticulum
Shin W.S.; Karam E.; Aizer A.; Holmes D.S.; Bernstein N.E.; Chinitz L.A.
2009 ;6(5 SUPPL 1):S88-S89, Heart rhythm
Introduction: Left ventricular diverticulum is a rare abnormality for which the etiology, management, and natural history are poorly understood. LV diverticuli are reported to be associated with ventricular tachycardia and sudden cardiac death, though the mechanisms of these ventricular arrhythmias have not been well characterized. Conversely, focal PVC triggers of idiopathic VF emanating from the distal Purkinje system have been well described. Here we report the first case of Purkinje fiber-mediated VF mapping to a LV diverticulum that was successfully treated with catheter ablation. Methods: N/A Results: An otherwise healthy 38 year old woman presented with sudden cardiac arrest. Electrocardiography demonstrated repeated episodes of polymorphic VT/VF. The initiating beats of VF were of a left-bundle branch pattern and were identical in ECG morphology to isolated PVCs that were observed in the aftermath of resuscitation. Cardiac MRI demonstrated a normal LVEF and, notably, a focal diverticulum at the inferoseptal wall. At electrophysiology study, a mapping/ablation catheter was positioned in the LV diverticulum via retrograde approach, where distinct purkinje potentials were noted to precede the onset of QRS complexes during sinus rhythm. Pace mapping from within the diverticulum demonstrated a 11/12 lead match for the index PVCs. Delivery of RF energy to this region terminated both the PVCs and future VF events. Conclusions: This is the first description of purkinje-fiber mediated VF mapping to a LV diverticulum and successfully treated with RF ablation. (Figure presented)
— id: 131851, year: 2009, vol: 6, page: S88, stat: Journal Article,

Standardization and validation of an automated algorithm to identify fractionation as a guide for atrial fibrillation ablation
Aizer, Anthony; Holmes, Douglas S; Garlitski, Ann C; Bernstein, Neil E; Smyth-Melsky, Jane M; Ferrick, Aileen M; Chinitz, Larry A
2008 Aug;5(8):1134-1141, Heart rhythm
BACKGROUND: Atrial fibrillation catheter ablation is frequently guided by identification of fractionated electrograms, which are thought to be critical for maintenance of the arrhythmia. Objective automated means for identifying fractionation independent of physician interpretation have not been standardized or validated. OBJECTIVE: The purpose of this study was to standardize and validate an automated algorithm to rapidly identify fractionated electrograms for high-density atrial fibrillation fractionation mapping. METHODS: Left and right atrial fractionation maps were generated by EnSite NavX 6.0 software, using standardized ablation catheters in eight patients with atrial fibrillation. Two blinded electrophysiologists interpreted all electrograms as either fractionated or not fractionated. A stepwise approach was used to optimize automated settings to accurately identify fractionation. High-density fractionation maps were generated with a 20-pole mapping catheter in eight other patients. Two blinded electrophysiologists interpreted all electrograms as near field or far field. The algorithm was refined to optimize settings to exclude far-field signals and retain near-field signals. The sampling segment length was adjusted to optimize recording time to ensure reproducibility. RESULTS: Using 1,514 points, the automated software achieved sensitivity of 0.75 and specificity of 0.80 for identification of fractionated electrograms. Using 725 points collected via multipole catheters with optimal automated settings, 94% of near-field fractionated electrograms were accurately identified. A 6-second sampling length was needed for reproducible fractionation measurements. CONCLUSION: Standardized settings of EnSite NavX 6.0 software with 6-second data collection per point can rapidly and accurately generate high-density fractionation maps independent of physician electrogram interpretation. This may allow for an automated, standardized approach to atrial fibrillation fractionated ablation
— id: 89057, year: 2008, vol: 5, page: 1134, stat: Journal Article,

Cosmic radiation induced software electrical resets in ICDs during air travel
Ferrick, Aileen M; Bernstein, Neil; Aizer, Anthony; Chinitz, Larry
2008 Aug;5(8):1201-1203, Heart rhythm
— id: 89056, year: 2008, vol: 5, page: 1201, stat: Journal Article,

The effect of transvenous pacemaker and implantable cardioverter defibrillator lead placement on tricuspid valve function: an observational study
Kim, Juyong B; Spevack, Daniel M; Tunick, Paul A; Bullinga, John R; Kronzon, Itzhak; Chinitz, Larry A; Reynolds, Harmony R
2008 Mar;21(3):284-287, Journal of the American Society of Echocardiography
This study assessed the effect of transtricuspid placement of permanent pacemaker (PPM) and implantable cardioverter defibrillator (ICD) leads on tricuspid regurgitation (TR) in 248 patients with echocardiograms before and after placement. Some 21.2% of patients with baseline mild TR or less developed abnormal TR (3.4% mild-moderate, 12.8% moderate, 1.1% moderate-severe, 3.9% severe) after implant. TR worsened by 1 grade or more after implant in 24.2% (20.7% of PPMs vs. 32.4% of ICDs; P < .05). TR worsening was more common with ICDs than PPMs in patients with baseline mild TR or less. After lead implantation, abnormal TR developed in 21.2% and severe TR developed in 3.9% of patients with initially normal TR. TR worsened by at least 1 grade in 24.2%. Patients with ICDs had a higher rate of TR worsening compared with patients with PPMs (32.4% vs. 20.1%; P < .05)
— id: 76454, year: 2008, vol: 21, page: 284, stat: Journal Article,

Evaluation of the accuracy of a microprocessor-assisted cardiac rhythm algorithm in the interpretation of paced electrocardiograms
Garlitski, A; Bernstein, N; Aizer, A; Holmes, D; Chinitz, L
2007 OCT ;18(7):S101-S102, Journal of cardiovascular electrophysiology
— id: 75695, year: 2007, vol: 18, page: S101, stat: Journal Article,

Challenging icd programming in a patient with catecholaminergic polymorphic ventricular tachycardia
Garlitski, A; Swingle, J; Holmes, D; Aizer, A; Bernstein, N; Chinitz, L
2007 OCT ;18(7):S90-S90, Journal of cardiovascular electrophysiology
— id: 75694, year: 2007, vol: 18, page: S90, stat: Journal Article,

Irregular junctional rhythm masquerading as chronic atrial fibrillation
Garlitski, A; Swinlge, J; Holmes, D; Aizer, A; Bernstein, N; Chinitz, L
2007 OCT ;18(7):S73-S73, Journal of cardiovascular electrophysiology
— id: 75693, year: 2007, vol: 18, page: S73, stat: Journal Article,

Evaluation of the abdominal aorta and the renal arteries with an intracardiac echocardiography probe placed in the inferior vena cava: a feasibility study
Kronzon, Itzhak; Chen, Carol; Chinitz, Larry A; Bernstein, Neil E; Slater, James N; Varkey, Mathew; Tunick, Paul A
2007 Feb;20(2):119-125, Journal of the American Society of Echocardiography
BACKGROUND: Ultrasound evaluation of the abdominal aorta and its branches is usually performed transabdominally. Not infrequently, the image quality is suboptimal. Recently, an intracardiac echocardiography probe has become commercially available. These probes are usually inserted intravenously and advanced to the right heart for diagnostic and monitoring purposes during procedures such as atrial septal defect closure and pulmonary vein isolation. Because of the close anatomic relation between the abdominal aorta and the inferior vena cava, we hypothesized that these probes would be useful in the evaluation of the abdominal aorta and the renal arteries. METHODS: Sixteen patients with normal renal function and no history of hypertension who were undergoing a pulmonary vein isolation procedure or atrial septal defect closure were studied. In each patient, the intracardiac echocardiography probe was inserted in the femoral vein and advanced to the right atrium for the evaluation of the left atrium and the pulmonary veins during the procedure. At the end of the therapeutic procedure, the probe was withdrawn into the inferior vena cava for the evaluation of the aorta and renal arteries. RESULTS: High-resolution images of the abdominal aorta from the diaphragm to its bifurcation were easily obtained in all patients. These images allowed for the evaluation of arterial size, shape, and blood flow. Both renal arteries were easily visualized in each patient. With the probe in the inferior vena cava, both renal arteries were parallel to the imaging plane and, therefore, accurate measurement of renal blood flow velocity and individual renal blood flow were measured
— id: 70878, year: 2007, vol: 20, page: 119, stat: Journal Article,

How to perform noncontact mapping
Chinitz, Larry A; Sethi, Jesse S
2006 Jan;3(1):120-123, Heart rhythm
— id: 62814, year: 2006, vol: 3, page: 120, stat: Journal Article,

Percutaneous treatment of the superior vena cava syndrome via an excimer laser sheath in a patient with a single chamber atrial pacemaker
Garlitski, Ann C; Swingle, Jad D; Aizer, Anthony; Holmes, Douglas S; Bernstein, Neil E; Chinitz, Larry A
2006 Sep;16(3):203-206, Journal of interventional cardiac electrophysiology
A 21-year-old woman presented with a pacemaker-associated superior vena cava (SVC) syndrome refractory to medical therapy. In the past, treatment of this condition has involved surgical exploration which is invasive. With the evolution of percutaneous techniques, treatment has included venoplasty and stenting over the pacemaker lead. There is limited experience with a more advanced percutaneous technique in which the lead is extracted by an excimer laser sheath. The extraction is immediately followed by venoplasty and stenting at the site of stenosis with subsequent implantation of a new permanent pacemaker at the previously occluded access site. The patient underwent this procedure which proved to be safe, minimally invasive, and an efficient method of treating SVC syndrome secondary to a single chamber atrial pacemaker
— id: 71862, year: 2006, vol: 16, page: 203, stat: Journal Article,

Comparison of left atrial volume and left atrial appendage contribution in patients with and without persistent atrial fibrillation
Srichai, MB; Jacobs, JE; Bernstein, N; Chinitz, L; Axel, L
2006 FEB 21 ;47(4):125A-125A, Journal of the American College of Cardiology
— id: 63302, year: 2006, vol: 47, page: 125A, stat: Journal Article,

A prospective, randomized trial of remote magnetic versus manual catheter navigation for ablation of supraventricular tachycardia (SVT): The stereotaxis heart trial
Wood, MA; Haffajee, CI; Ellenbogen, KA; Ramaswamy, K; Wilkinson, DV; Johnson, EE; Wharton, JM; Chinitz, LA; Zivin, AH; Doyle, TK; Warner, K; Sehra, R
2006 OCT 31 ;114(18):705-705, Circulation
— id: 69561, year: 2006, vol: 114, page: 705, stat: Journal Article,

Performance of a new cardiac cryoablation system in the treatment of cavotricuspid valve isthmus-dependent atrial flutter
Daubert, JP; Hoyt, RH; John, R; Chinitz, L; Martin, DT; Fellows, C; Feld, G; Pelkey, W; Sehra, R
2005 JAN ;28(8):S142-S145, Pacing & clinical electrophysiology
Performance of a New Cardiac Cryoablation System in the Treatment of Cavotricuspid Valve Isthmus-Dependent Atrial Flutter. We sought to evaluate prospectively the safety and efficacy of cryothermal energy to ablate typical atrial flutter (AFL). Ablation of cardiac tissue using cryothermal energy has recently been developed as an alternative to radiofrequency energy, which may offer certain advantages in the treatment of AFL. This prospective, multicenter nonrandomized study of a new catheter-based system for the treatment of cavotricuspid isthmus (CTI)-dependent AFL enrolled patients between 18 and 75 years of age. The CTI dependence of AFL was confirmed at electrophysiologic study with activation mapping and/or entrainment. Patients with atrial septal defect, recent myocardial infarction, left ventricular ejection fraction <0.30, or prior AFL ablation were excluded. Cryoablation of AFL was performed in 48 patients from 11 centers. The procedure was immediately successful in 45 patients (94%), and effective in 30 of 40 patients with complete data available at 6 months. Cryoablation is a promising new treatment of CTI-dependent AFL refractory to medical therapy. Further improvements in catheter design and intravascular sheaths will be tested in a larger multicenter trial
— id: 49014, year: 2005, vol: 28, page: S142, stat: Journal Article,

Why a sawtooth? Inferences on the generation of the flutter wave during typical atrial flutter drawn from radiofrequency ablation
Bernstein, Neil E; Sandler, David A; Goh, Mark; Feigenblum, David Y; Holmes, Douglas S; Chinitz, Larry A
2004 Oct;9(4):358-361, Annals of noninvasive electrocardiology
BACKGROUND: Typical atrial flutter (AFL) is a macroreentrant arrhythmia characterized by a counterclockwise circuit that passes through the cavotricuspid isthmus with passive depolarization of the left atrium. These electrical events are thought to be responsible for the classic 'sawtooth' wave of atrial flutter seen on the surface electrocardiogram characterized by a gradual downward deflection followed by a sharp negative deflection. It has been suggested that the negative flutter wave is a result of passive depolarization of the left atrium. We hypothesized that interruption of the circuit within the isthmus would prevent the reentrant wave from depolarizing the left atrium thus eliminating the component of the electrocardiogram reflecting left atrial depolarization. METHODS: We examined 100 cases of atrial flutter with the typical 'sawtooth' pattern referred for radiofrequency ablation. Ninety-seven of the 100 were successfully ablated. All cases were reviewed for termination of atrial flutter with the last intracardiac electrogram just lateral to the site of linear ablation and surface flutter wave at the moment of termination not obscured by the QRS segment or the T-wave. Seventeen of the 97 met these criteria. RESULTS: Seventeen of the 17 cases demonstrated a gradual negative deflection as the last discernible wave of atrial activity followed by an isoelectric period and resumption of normal sinus rhythm. The last generated wave lacked the sharp negative downstroke. CONCLUSION: These results suggest that the sharp negative deflection of flutter waves likely correlates with the wavefront's penetration of the interatrial septum and passive depolarization of the left atrium
— id: 48236, year: 2004, vol: 9, page: 358, stat: Journal Article,

Results of catheter ablation of typical atrial flutter
Calkins, H; Canby, R; Weiss, R; Taylor, G; Wells, P; Chinitz, L; Milstein, S; Compton, S; Oleson, K; Sherfesee, L; Onufer, J
2004 AUG 15 ;94(4):437-442, American journal of cardiology
The purpose of this study was to evaluate the safety and efficacy of radiofrequency (RF) ablation of typical atrial flutter by using an 8-mm electrode catheter and a 100-W RF power generator. A limitation of previous trials of catheter ablation of atrial flutter is that the data were not collected as part of a prospective multicenter clinical trial. The study results associated catheter ablation of typical atrial flutter in a cohort of 150 patients with an 88% acute efficacy rate. At 6-month follow-up, recurrent typical atrial flutter was observed in 13% of patients. Of the 12 patients with typical atrial flutter recurrence, 4 were symptomatic and 8 were asymptomatic. Procedure duration was a significant predictor of typical atrial flutter recurrence. The 12-month rate for development of atrial fibrillation was 30%. Catheter ablation of atrial flutter was associated with significant improvements in 5 of 8 domains of the Short Form 36 Survey (quality of life) and significant decreases in 13 of the 16 symptoms of the Symptom Checklist. The device- or procedure-related complication rate was 2.7%. Skin burns occurred at the dispersive pad site due to stronger RF power in 3 patients. Use of a dual dispersive pad system mitigated this problem. Thus, the results of this study associated catheter ablation of atrial flutter with high acute efficacy, a small risk of recurrent atrial flutter, and an important risk of atrial fibrillation during follow-up. (C) 2004 by Excerpta Medica, Inc
— id: 46549, year: 2004, vol: 94, page: 437, stat: Journal Article,

BREATHE: base rest rate evaluation of apnea therary
Chinitz L; Duran L; Francoz R; Brown S; Black J; Krieger AC; Rapoport D
2003 ;91:A50-A50, Journal of the American College of Cardiology
— id: 56240, year: 2003, vol: 91, page: A50, stat: Journal Article,

Drug therapy and microvolt T-wave alternans testing
Jauhar, Sandeep; Chinitz, Larry; Jorde, Ulrich
2003 Oct 25;362(9393):1417-1418, Lancet
— id: 47322, year: 2003, vol: 362, page: 1417, stat: Journal Article,

Pulmonary vein isolation during minimally invasive mitral valve surgery: One-year follow-up
Mirchandani, S; Holmes, DS; Chinitz, LA; Bernstein, NE; Applebaum, RM; Colvin, SB; Galloway, AC; Grossi, EA
2002 Mar 6;39(5):120A-120A, Journal of the American College of Cardiology
— id: 27516, year: 2002, vol: 39, page: 120A, stat: Journal Article,

Cardiac vein angioplasty for biventricular pacing
Sandler, David A; Feigenblum, David Y; Bernstein, Neil E; Holmes, Douglas S; Chinitz, Larry A
2002 Dec;25(12):1788-1789, Pacing & clinical electrophysiology
Biventricular pacing for the treatment of congestive heart failure has consistently demonstrated improvement in quality-of-life and reduction in heart failure symptoms. Though the over-the-wire systems will be helpful in overcoming many existing obstacles to optimal lead placement, anatomic variability will still limit overall success. Cardiac vein angioplasty may be required for deployment of leads into tortuous or obstructed cardiac veins. This case report describes the angioplasty of a focal cardiac vein stenosis allowing for successful implantation of a left ventricular pacing lead. The safety of this procedure is unknown, though the risks may be acceptable in certain patients
— id: 96172, year: 2002, vol: 25, page: 1788, stat: Journal Article,

T-Wave alternans during ventricular pacing
Fedor, MC; Chinitz, JS; Holmes, DS; Bernstein, NE; Ruffo, S; Manaris, A; Balch, LJ; Slater, W; Rey, M; Chinitz, LA
2000 FEB ;35(2):145A-145A, Journal of the American College of Cardiology
— id: 54748, year: 2000, vol: 35, page: 145A, stat: Journal Article,

Amiodarone inhibits cardiac ATP-sensitive potassium channels
Holmes DS; Sun ZQ; Porter LM; Bernstein NE; Chinitz LA; Artman M; Coetzee WA
2000 Oct;11(10):1152-1158, Journal of cardiovascular electrophysiology
INTRODUCTION: ATP-sensitive K+ channels (K(ATP)) are expressed abundantly in cardiovascular tissues. Blocking this channel in experimental models of ischemia can reduce arrhythmias. We investigated the acute effects of amiodarone on the activity of cardiac sarcolemmal K(ATP) channels and their sensitivity to ATP. METHODS AND RESULTS: Single K(ATP) channel activity was recorded using inside-out patches from rat ventricular myocytes (symmetric 140 mM K+ solutions and a pipette potential of +40 mV). Amiodarone inhibited K(ATP) channel activity in a concentration-dependent manner. After 60 seconds of exposure to amiodarone, the fraction of mean patch current relative to baseline current was 1.0 +/- 0.05 (n = 4), 0.8 +/- 0.07 (n = 4), 0.6 +/- 0.07 (n = 5), and 0.2 +/- 0.05 (n = 7) with 0, 0.1, 1.0, or 10 microM amiodarone, respectively (IC50 = 2.3 microM). ATP sensitivity was greater in the presence of amiodarone (EC50 = 13 +/- 0.2 microM in the presence of 10 microM amiodarone vs 43 +/- 0.1 microM in controls, n = 5; P < 0.05). Kinetic analysis showed that open and short closed intervals (bursting activity) were unchanged by 1 microM amiodarone, whereas interburst closed intervals were prolonged. Amiodarone also inhibited whole cell K(ATP) channel current (activated by 100 microM bimakalim). After a 10-minute application of amiodarone (10 microM), relative current was 0.71 +/- 0.03 vs 0.92 +/- 0.09 in control (P < 0.03). CONCLUSION: Amiodarone rapidly inhibited K(ATP) channel activity by both promoting channel closure and increasing ATP sensitivity. These actions may contribute to the antiarrhythmic properties of amiodarone
— id: 39525, year: 2000, vol: 11, page: 1152, stat: Journal Article,

Rapid pulmonary vein isolation for atrial fibrillation during minimally invasive mitral valve surgery
Holmes, DS; Chinitz, LA; Pierce, WJ; Bernstein, NE; Applebaum, RM; Colvin, SB; Galloway, AC; Grossi, EA
2000 OCT 31 abstract #2351;102(18):484-484, Circulation
— id: 33424, year: 2000, vol: 102, page: 484, stat: Journal Article,

Amiodarone inhibits cardiac ATP-Sensitive K+ channels
Holmes, DS; Sun, ZQ; Porter, L; Artman, M; Chinitz, L; Coetzee, WA
2000 FEB ;35(2):97A-97A, Journal of the American College of Cardiology
— id: 54747, year: 2000, vol: 35, page: 97A, stat: Journal Article,

Atrial arrhythmia following a biatrial approach to mitral valve surgery
Bernstein NE; Skipitaris NT; Glotzer TV; Delianides J; Chinitz LA; Colvin S
1996 Nov;19(11 Pt 2):1944-1946, Pacing & clinical electrophysiology
The biatrial approach to exposing the mitral valve during surgery has the potential for improving visualization of the valve with minimal cardiac manipulation. This procedure, involving a right atriotomy and an extended transseptal incision, may isolate the sinus node from its normal blood supply and autonomic innervation. Thirty-eight consecutive patients undergoing this procedure were examined. Twenty-two of these patients (58%) were admitted in normal sinus rhythm and 15 (40%) were in atrial fibrillation (AF) or atrial flutter. Of the 22 patients admitted in normal sinus rhythm, only 3 patients remained in this rhythm at discharge. Fourteen of the 22 patients were discharged in a slow, low atrial rhythm. All of the patients admitted in AF were discharged in AF. Of the 14 patients discharged in a low atrial rhythm, the rhythm persisted in eleven patients (80%) at a mean of 6-month follow-up. The routine use of this transseptal approach to mitral valve surgery needs further assessment in light of the predictable loss of the sinus mechanism
— id: 12490, year: 1996, vol: 19, page: 1944, stat: Journal Article,

Mapping reentry around atriotomy scars using double potentials
Chinitz LA; Bernstein NE; O'Connor B; Glotzer TV; Skipitaris NT
1996 Nov;19(11 Pt 2):1978-1983, Pacing & clinical electrophysiology
Supraventricular arrhythmias, often seen in patients after cardiac surgery, may be associated with scars produced in the atria at the time of surgery. Double potentials, found in the presence of functional or anatomical block, can define the limits and critical regions of a reentrant circuit associated with the atriotomy scars. We describe six patients with seven distinct atrial tachycardias in whom atriotomy scars were successfully mapped during intraatrial reentry utilizing the presence and interelectrogram relationship of observed double potentials. The reentrant circuit was mapped in all patients by following the relationship between double potentials along the surgical scar, assuming that they would be widely split in the middle of the scar and merge into a single continuous fractionated potential at the apex of the scar. At this site, atrial pacing was performed to entrain the tachycardia and confirm the participation of the atriotomy scar in the clinically relevant atrial tachycardia. Radiofrequency ablation was performed from the site of electrogram fusion to the nearest anatomical obstacle. Five of seven atrial tachycardias were successfully ablated utilizing this technique over a mean follow-up of 10 months. We proposed that these double potentials and their interelectrogram relationship are an effective means of mapping atriotomy scars and guiding successful radiofrequency ablation
— id: 12489, year: 1996, vol: 19, page: 1978, stat: Journal Article,

Incomplete occlusion of left ventricular aneurysms after endoventricular aneurysmorrhaphy: diagnosis by echocardiography and ventriculography
Katz ES; Applebaum RM; Pierson C; Chinitz L; Colvin SB; Kronzon I
1996 May;38(1):96-99, Catheterization & cardiovascular diagnosis
Surgical treatment of left ventricular aneurysms have recently focused on maintaining normal left ventricular geometry by using a circular patch repair to exclude the aneurysmal cavity (endoaneurysmorrhaphy). We describe two patients who underwent this procedure and were subsequently found by echocardiography and angiography to have a residual communication between the left ventricular cavity and the aneurysm which contained thrombus. This finding may have implications regarding the optimal hemodynamic result of the surgery and the risk of thromboembolism
— id: 12616, year: 1996, vol: 38, page: 96, stat: Journal Article,

Endoventricular remodeling of left ventricular aneurysm. Functional, clinical, and electrophysiological results
Grossi EA; Chinitz LA; Galloway AC; Delianides J; Schwartz DS; McLoughlin DE; Keller N; Kronzon I; Spencer FC; Colvin SB
1995 Nov 1;92(9 Suppl):II98-I100, Circulation
BACKGROUND: Recent advances in surgical techniques for the repair of left ventricular aneurysms (LVAs) include the use of an endoventricular patch to exclude the aneurysm cavity. This technique has replaced conventional linear plication of the aneurysm. The endoventricular patch technique remodels the left ventricular cavity to a more physiological geometry that improves function. METHODS AND RESULTS: From December 1989 through November 1993, 45 patients underwent an LVA repair with an endoventricular patch. This procedure was performed in association with coronary artery bypass grafting in 40 patients. Twenty-eight patients (62.2%) also had nonguided encircling subendocardial incisions. Operative procedures included 7 emergency operations, 3 concomitant valve procedures, and a mean of 2.2 bypass grafts per patient. Eight patients had previous cardiac operations. Hospital mortality was 15.6% (7/45) for all patients and 9.1% (3/33) for nonemergent revascularization and LVA repairs. Ejection fraction improved from a mean of 25.8% preoperatively to 37.8% postoperatively; the mean New York Heart Association classification improved from 3.5 to 1.5. Of patients known to have preoperative arrhythmias (inducible or sudden death), 69% were not inducible postoperatively without antiarrhythmic medication. Survival from late cardiac death (including death of unknown origin) was 86.5% at 2 years. Freedom from documented ventricular arrhythmias was 94.3% at 2 years. CONCLUSIONS: These results indicate that the patch endoaneurysmorrhaphy technique can provide an excellent functional and physiological outcome in patients with LVAs and severely impaired ventricular function
— id: 56759, year: 1995, vol: 92, page: II98, stat: Journal Article,

Echocardiographic evaluation of the coronary sinus
Kronzon I; Tunick PA; Jortner R; Drenger B; Katz ES; Bernstein N; Chinitz LA; Freedberg RS
1995 Jul-Aug;8(4):518-526, Journal of the American Society of Echocardiography
The purpose of this study was to compare transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in the evaluation of the coronary sinus and its blood flow. Forty patients were studied by TTE and TEE. The distal coronary sinus and its right atrial communication could be identified in 21 of 40 by TTE, and in all patients by TEE. Coronary sinus diameter measurement at the right atrial communication was possible by TTE in 16 of 40, and in all patients by TEE (maximal diameter 6 to 14 mm, mean 9 +/- 2). Flow velocity measurement by pulsed Doppler was possible in 25 of 40 patients (63%) by TEE, and in none by TTE. The flow velocity pattern was similar to central vein flow velocity, with systolic and diastolic antegrade waves, and a small retrograde end diastolic wave. The coronary sinus cross-sectional area was measured in 5 patients by intravascular ultrasound. It varied in size and shape during the cardiac cycle, reaching a maximum (0.3 to 1.5 cm2) at end diastole, and decreasing by 40% to 70% at end systole. TEE is superior to TTE in the evaluation of the coronary sinus and its blood flow velocity. However, because of the variability in cross-sectional area size and shape, measurement of coronary sinus blood flow may be inaccurate
— id: 6924, year: 1995, vol: 8, page: 518, stat: Journal Article,

SUCCESSFUL RADIOFREQUENCY ABLATION OF ATRIAL-FLUTTER WITH LINEAR LESIONS
CHINITZ, L; BERNSTEIN, N; GUARNERI, E; GLOTZER, T
1994 FEB ;37(4):A342-A342, Journal of the American College of Cardiology
— id: 52303, year: 1994, vol: 37, page: A342, stat: Journal Article,

Specificity of retrograde conduction in screening for atrioventricular nodal reentrant tachycardia
Glotzer T; Evans S; Bernstein N; Chinitz L
1994 Nov;17(11 Pt 2):2134-2136, Pacing & clinical electrophysiology
Baseline AV conduction properties (antegrade and retrograde) are often used to assess the presence of dual AV nodal physiology or concealed AV accessory pathways. Although retrograde conduction (RET) is assumed to be a prerequisite for AV nodal reentrant tachycardia (AVNRT), its prevalence during baseline measurements has not been evaluated. We reviewed all cases of AVNRT referred for radiofrequency ablation to determine the prevalence of RET at baseline evaluation and after isoproterenol infusion. Results: Seventy-three patients with AVNRT underwent full electrophysiological evaluation. Sixty-six patients had manifest RET and inducible AVNRT during baseline atrial and ventricular stimulation. Seven patients initially demonstrated complete RET block despite antegrade evidence of dual AV nodal physiology. In 3 of these 7 patients AVNRT was inducible at baseline despite the absence of RET. In the other four patients isoproterenol infusion was required for induction of AVNRT, however only 3 of these 4 patients developed RET. One of these remaining patients had persistent VA block after isoproterenol. Conclusions: The induction of AVNRT in the absence of RET suggests that this is not an obligatory feature of this arrhythmia. Therefore, baseline AV conduction properties are unreliable in assessing the presence of AVNRT and isoproterenol infusions should be used routinely to expose RET and reentrant tachycardia
— id: 6628, year: 1994, vol: 17, page: 2134, stat: Journal Article,

ENDOVENTRICULAR REMODELING FOR LV ANEURYSM - FUNCTIONAL AND ELECTROPHYSIOLOGICAL RESULTS
GROSSI, EA; CHINITZ, LA; GALLOWAY, AC; DELIANIDES, J; KRONZON, I; SPENCER, FC; COLVIN, SB
1994 OCT ;90(4):640-640, Circulation
— id: 33449, year: 1994, vol: 90, page: 640, stat: Journal Article,

Percutaneous left atrial to femoral arterial bypass pumping for circulatory support in high-risk coronary angioplasty [see comments]
Glassman E; Chinitz LA; Levite HA; Slater J; Winer H
1993 Jul;29(3):210-216, Catheterization & cardiovascular diagnosis
Left atrial to femoral arterial bypass was evaluated as a means of supporting patients who were considered to be at high risk for the performance of percutaneous transluminal coronary angioplasty. A 20 French drainage catheter was inserted percutaneously into the left atrium via a modified transseptal technique. Blood was withdrawn from the left atrium and returned through a femoral arterial cannula using a roller pump. Thirteen patients were treated in this fashion with excellent circulatory support. Pump flows varied from 1.5 to 3 liters per minute and bypass time ranged from 27 to 106 min (mean = 43 +/- 17). Aortic mean pressure was well supported during balloon inflation. No significant complications were encountered. Neither an oxygenator nor a perfusionist is required. The ability to obtain direct left ventricular decompression offers a major potential advantage. Further evaluation of this technique for the support of such patients is indicated
— id: 6384, year: 1993, vol: 29, page: 210, stat: Journal Article,

HEART-RATE-VARIABILITY CORRELATES WITH THE ELECTROCARDIOGRAPHIC QT INTERVAL IN A HEALTHY POPULATION
DEMAZUMDER, D; SCHWARTZMAN, D; GLICKSTEIN, J; CHINITZ, L
1992 OCT ;40(3):A654-A654, Clinical research
— id: 51876, year: 1992, vol: 40, page: A654, stat: Journal Article,

Autonomic manipulation influences both temporal and frequency analyses of late potentials
Schwartzman D; Demopoulos L; Schrem S; Caracciolo E; Perez J; Chinitz L; Slater W
1992 Nov;15(11 Pt 2):2200-2205, Pacing & clinical electrophysiology
Previous studies of late potentials have not standardized the autonomic milieu at the time of testing. We studied the effects of autonomic manipulation in seven patients with previous Q wave myocardial infarction. Late potentials were evaluated using standard temporal (TD) and spectral temporal mapping techniques (STM) in the drug free state, and during separate intravenous administration of each of the following: isoproterenol, esmolol, and atropine. Isoproterenol was titrated to achieve a heart rate of 130% of baseline. Esmolol was infused at a rate of 250 micrograms/kg per minute, after a loading dose of 500 micrograms/kg. Atropine was given as a 2-mg bolus. In addition, five patients who received no drug infusions acted as controls, undergoing four serial signal-averaging studies in the baseline state: a 'baseline' study, and then three additional studies at time intervals similar to those incurred by the study patients. Therefore, a total of 21 TD and 21 STM tests were done in the study group (seven patients; three drugs per patient) during the drug infusions, and 15 TD and 15 STM tests were done in the control group (five patients; three 'nonbaseline' tests per patient). A change (normal to abnormal, or vice versa) in TD during a drug infusion occurred in 24% of the tests. No such change occurred in the control group (P < 0.01). A change in STM during a drug infusion occurred in 38% of tests, versus 13% of tests in the control group (P = 0.14). Overall, six of seven patients had a change in TD and/or STM diagnosis with infusion of one or more of the study drugs.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 13392, year: 1992, vol: 15, page: 2200, stat: Journal Article,

PERCUTANEOUS LEFT ATRIAL FEMORAL BYPASS FOR THE TREATMENT OF CARDIOGENIC-SHOCK
WINER, HE; GLASSMAN, E; SLATER, J; CHINITZ, LA; LEVITE, HA; RIBAKOVE, G
1992 JUL-AUG ;4(6):300-302, Journal of invasive cardiology
— id: 51906, year: 1992, vol: 4, page: 300, stat: Journal Article,

Percutaneous mitral valvuloplasty following surgical repair of sinus venosus atrial septal defect
Gerber R; Sedlis SP; Tunick PA; Chinitz L; Altszuler H; Gindea A
1991 Aug;23(4):297-299, Catheterization & cardiovascular diagnosis
Mitral valvuloplasty performed 5 y after repair of a sinus venosus ASD was difficult because of a thickened septum, but resulted in improved mitral valve opening and did not lead to ASD. Thus, prior repair of a sinus venosus ASD may not be an absolute contraindication to mitral valvuloplasty
— id: 13949, year: 1991, vol: 23, page: 297, stat: Journal Article,

Comparison of cardiac catheterization and Doppler echocardiography in the decision to operate in aortic and mitral valve disease [see comments]
Slater J; Gindea AJ; Freedberg RS; Chinitz LA; Tunick PA; Rosenzweig BP; Winer HE; Goldfarb A; Perez JL; Glassman E; et al
1991 Apr;17(5):1026-1036, Journal of the American College of Cardiology
Clinical decisions utilizing either Doppler echocardiographic or cardiac catheterization data were compared in adult patients with isolated or combined aortic and mitral valve disease. A clinical decision to operate, not operate or remain uncertain was made by experienced cardiologists given either Doppler echocardiographic or cardiac catheterization data. A prospective evaluation was performed on 189 consecutive patients (mean age 67 years) with valvular heart disease who were being considered for surgical treatment on the basis of clinical information. All patients underwent cardiac catheterization and detailed Doppler echocardiographic examination. Three sets of two cardiologist decision makers who did not know patient identity were given clinical information in combination with either Doppler echocardiographic or cardiac catheterization data. The combination of Doppler echocardiographic and clinical data was considered inadequate for clinical decision making in 21% of patients with aortic and 5% of patients with mitral valve disease. The combination of cardiac catheterization and clinical data was considered inadequate in 2% of patients with aortic and 2% of patients with mitral valve disease. Among the remaining patients, the cardiologists using echocardiographic or angiographic data were in agreement on the decision to operate or not operate in 113 (76% overall). When the data were analyzed by specific valve lesion, decisions based on Doppler echocardiography or catheterization were in agreement in 92%, 90%, 83% and 69%, respectively, of patients with aortic regurgitation, mitral stenosis, aortic stenosis and mitral regurgitation. Differences in cardiac output determination, estimation of valvular regurgitation and information concerning coronary anatomy were the main reasons for different clinical management decisions. These results suggest that for most adult patients with aortic or mitral valve disease, alone or in combination, Doppler echocardiographic data enable the clinician to make the same decision reached with catheterization data
— id: 14079, year: 1991, vol: 17, page: 1026, stat: Journal Article,

Echocardiographic and hemodynamic characteristics of atrial septal defects created by percutaneous valvuloplasty
Kronzon I; Tunick PA; Goldfarb A; Freedberg RS; Chinitz L; Slater J; Schwinger ME; Gindea AJ; Glassman E; Daniel WG
1990 Jan-Feb;3(1):64-71, Journal of the American Society of Echocardiography
Twenty-nine patients were studied by pulsed, continuous wave, and color Doppler before and after percutaneous transseptal valvuloplasty. New atrial septal defects were detected in 14 patients, and the patients were monitored for up to 320 days after the procedure. The diameter of the defect, best evaluated by the transesophageal approach, was 3 to 15 mm. A narrow, high velocity (1.4 to 3.1 meters per second) left-to-right shunt jet was detected in 13 of 14 patients. The shunt jet was continuous in nine of 14 patients, late systolic-holodiastolic in four patients, and bidirectional in one patient. Cardiac catheterization in nine patients confirmed the Doppler findings and demonstrated a peak pressure gradient of 10 to 32 mm Hg between the left and right atria. Oximetry revealed a calculated pulmonary to systemic flow ratio ranging from 2.3:1 in the patient with the largest atrial septal defect by echocardiography to 1:1 (no oxygen saturation step-up) in the patient with the smallest atrial septal defect. In the three patients who underwent cardiac surgery, the operative findings confirmed those of echocardiography. We concluded that atrial septal defects are common after transseptal valvuloplasty. Usually, their relatively small size and the underlying valvular disease that produces high left atrial pressure are responsible for the high pressure gradient between the left and right atria. This results in the high velocity and continuous shunt jet detected by Doppler echocardiography
— id: 63046, year: 1990, vol: 3, page: 64, stat: Journal Article,

High flow velocity across a complicated atrial septal defect: Doppler findings and hemodynamic correlations
Goldfarb A; Chinitz LA; Kronzon I
1988 Sep-Oct;1(5):348-350, Journal of the American Society of Echocardiography
An unusually high atrial shunt flow velocity pattern was recorded in a patient whose atrial septal defect was created iatrogenically during a transatrial septal approach to aortic valvuloplasty. The flow velocity pattern measured by Doppler echocardiography was predictive of the high transatrial pressure gradient noted later at catheterization
— id: 10967, year: 1988, vol: 1, page: 348, stat: Journal Article,

Total occlusion of the abdominal aorta in a patient with Takayasu's arteritis: the importance of lower rib notching in the differential diagnosis
Chinitz, L A; Kronzon, I; Trehan, N; Kang, J G
1986 ;12(6):405-408, Catheterization & cardiovascular diagnosis
— id: 100119, year: 1986, vol: 12, page: 405, stat: Journal Article,

Acquired immune deficiency syndrome possibly related to transfusion in an adult without known disease-risk factors
Gordon SM; Valentine FT; Holzman RS; Holliday RA; Baggott B; Chinitz LA; Brick PD
1984 Jun;149(6):1030-1032, Journal of infectious diseases
— id: 15513, year: 1984, vol: 149, page: 1030, stat: Journal Article,